Annals of Surgical Oncology

, Volume 21, Supplement 3, pp 385–389 | Cite as

Accuracy of CT Staging of Locally Advanced Gastric Cancer after Neoadjuvant Chemotherapy: Cohort Evaluation within a Randomized Phase II Study

  • Takaki Yoshikawa
  • Kazuaki Tanabe
  • Kazuhiro Nishikawa
  • Yuichi Ito
  • Takanori Matsui
  • Yutaka Kimura
  • Shinichi Hasegawa
  • Toru Aoyama
  • Tsutomu Hayashi
  • Satoshi Morita
  • Yumi Miyashita
  • Akira Tsuburaya
  • Junichi Sakamoto
Gastrointestinal Oncology



Accuracy of the radiologic diagnosis of gastric cancer staging after neoadjuvant chemotherapy remains unclear.


Patients enrolled in the COMPASS trial, a randomized phase II study comparing two and four courses of S-1 plus cisplatin and paclitaxel and cisplatin followed by gastrectomy, were examined. The radiologic stage was determined by using thin-slice computed tomography (CT) or multidetector low CT by following Habermann’s method.


A total of 75 patients registered in the COMPASS study who underwent surgical resection were examined in this study. The radiologic T and pathologic T stages were not significantly correlated (p = 0.221). The radiologic accuracy and rates of underdiagnosis and overdiagnosis were 42.7, 10.7, and 46.7%, respectively. When patients were stratified according to the pathologic response of the primary tumor, the correlation was not significant in either the responders (n = 32, p = 0.410) or the nonresponders (n = 43, p = 0.742). The radiologic accuracy was 37.5% in the responders and 42.7% in the nonresponders. The radiologic N and pathologic N stages were significantly correlated (p = 0.000). The radiologic accuracy and rates of underdiagnosis and overdiagnosis were 44, 29.3, and 26.7%, respectively. When stratifying the patients with measurable lymph nodes according only to the radiologic response, the correlation was significant in the nonresponders (n = 23, p = 0.035) but not in the responders (n = 28, p = 0.634). The radiologic accuracy was 39.3% in the responders and 52.1% in the nonresponders.


Restaging using CT after neoadjuvant chemotherapy for gastric cancer is considered to be inaccurate and unreliable. In particular, the radiologic T-staging determined after neoadjuvant chemotherapy should not be considered in clinical decision-making.


Gastric Cancer Paclitaxel Pathologic Response Peritoneal Metastasis Radiologic Response 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported by the Epidemiological & Clinical Research Information Network (ECRIN).


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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Takaki Yoshikawa
    • 1
  • Kazuaki Tanabe
    • 2
  • Kazuhiro Nishikawa
    • 3
  • Yuichi Ito
    • 4
  • Takanori Matsui
    • 5
  • Yutaka Kimura
    • 6
  • Shinichi Hasegawa
    • 1
  • Toru Aoyama
    • 1
  • Tsutomu Hayashi
    • 1
  • Satoshi Morita
    • 7
  • Yumi Miyashita
    • 8
  • Akira Tsuburaya
    • 9
  • Junichi Sakamoto
    • 10
  1. 1.Department of Gastrointestinal SurgeryKanagawa Cancer CenterYokohamaJapan
  2. 2.Department of Gastrointestinal SurgeryHiroshima UniversityHiroshimaJapan
  3. 3.Department of SurgeryOsaka General Medical CenterOsakaJapan
  4. 4.Department of Gastroenterological SurgeryAichi Cancer CenterNagoyaJapan
  5. 5.Department of SurgeryAichi Cancer Center, Aichi HospitalOkazakiJapan
  6. 6.Department of SurgeryNTT West Osaka HospitalOsakaJapan
  7. 7.Department of Biostatistics and EpidemiologyYokohama City University Medical CenterYokohamaJapan
  8. 8.Data Center, Nonprofit Organization ECRINOkazakiJapan
  9. 9.Clinical Research CenterShonan Kamakura General HospitalKamakuraJapan
  10. 10.Tokai Central HospitalKakamigaharaJapan

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